Senior Director of Quality

Amida Care, the largest Medicaid HIV Special Needs Plan in NY, delivers a uniquely effective care model that has become a true benchmark for innovation, engagement, and member health outcomes. Our mission is to provide access to comprehensive care and coordinated services that facilitate positive health outcomes and general well-being for our members. This true integrative care model addresses psychosocial, housing, behavioral and medical services directly evolving around the needs of each member.

We are a community of individuals from diverse peoples who work together to actively foster a fair, equitable, inclusive environment where all employees receive an invitation to belong.

We are actively seeking a highly motivated, innovative, and experienced individual to join our team as the Senior Director of Quality. Compensation will be commensurate with experience.

Position Summary:

In collaboration with and under the direction of our Medical Director, the Senior Director of Quality provides strategic, operational, and thought leadership to support Amida Care’s mission and vision to improve the health and well-being of our members. The Senior Director coordinates organization-wide efforts to ensure that quality improvement (QI) programs are developed and managed using a data-driven focus that sets priorities for improvements aligned to ongoing organizational strategic goals. This position provides leadership in the implementation of the Quality program, and management of the annual HEDIS/QARR submission. The Senior Director of Quality monitors, reports, and analyzes utilization of health care services by members, and evaluates the performance of care delivered by the provider network. The Senior Director provides oversight of the Quality program and collaborates with the Medical Director/CMO, to share insights and offer comprehensive program strategies to ensure that Amida Care’s population has access to high-quality, cost-effective health care services. Oversees quality audits, including but not limited to IPRO and HIV related reports (ETE). This includes partnering with other functional areas within Amida Care, providers, vendors, regulators, and community partners.

Responsibilities:

– Manage the quality metrics portion of the Value Based Contracts including generation of performance reports, data collection and assimilation, and reporting of performance with providers on a quarterly basis. Support enhancement of the VBP programs to align with the NYSDOH requirements
– Guide the Medical Informatics team towards development of a comprehensive reporting infrastructure to support all quality management projects and reporting/analytical needs for Health Services.
– Work with IT department to enhance data infrastructure that supports the needs of the Health Services area and regulatory needs. Support efforts to improve data completeness and validity for clinical reporting through participation in the data governance committee and collaborative projects with IT.
– Work with the Medical Director to implement a performance improvement plans, as well as enhanced data access, to improve HEDIS measure scores.
– Closely collaborates with VP of IT and IT department on implementing required IT changes to support Quality improvement activities and Corrective action plans
– Oversee the annual HEDIS submission, IPRO review, and any other State required Quality reports
– Maintain compliance with clinical quality regulatory requirements, including the development and reporting of QMP, PIP, CAP, special studies, and Performance Improvement initiatives as needed.
– Support clinical vendor management and enhance collaboration between Health Services division and other Amida Care departments. Create and implement framework for data sharing and regular reporting on key clinical and quality metrics with clinical vendors regularly and at quarterly DVO meetings.
– Assist with the development of an analytical/reporting infrastructure to support research and clinical studies.
– Lead and participate in the onsite audits associated with HEDIS/QARR.
– Collaborate with the Medical Director on reports needed for the quarterly Quality Management Committee meeting and Board meetings.
– Participate in the monthly Clinical Subcommittee meetings.
– Participate in relevant external community and regulatory meetings as need.
– Perform other duties as assigned.

Amida Care is a Diversity, Equity, and Inclusion employer committed to full inclusion and elimination of discrimination in all its forms. We strive to develop, promote, and sustain a culture that values equity and leverages diversity and inclusiveness in all that we do.

Amida Care requires that all candidates selected for employment must provide proof of full Covid-19 Vaccination upon acceptance of an offer of employment.

EDUCATION REQUIRED

Master’s degree in business or public administration or a health-related field or a combination of relevant work experience.

EXPERIENCES AND/OR SKILLS REQUIRED

– Five years of experience in quality management and HEDIS/QARR.
Strong knowledge of Microsoft Office (Word, Access, and Excel).
– Demonstrate understanding and sensitivity to multi-cultural values, beliefs, and attitudes of both internal and external contacts.
– Demonstrate appropriate behaviors in accordance with the organization’s vision, mission, and values.

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